TY - JOUR
T1 - Studies of the retinal microcirculation using human donor eyes and high-resolution clinical imaging
T2 - Insights gained to guide future research in diabetic retinopathy
AU - Balaratnasingam, Chandrakumar
AU - An, Dong
AU - Hein, Martin
AU - Yu, Paula
AU - Yu, Dao Yi
N1 - Funding Information:
The authors thank the Lions Eye Bank of Western Australia, and DonateLife Western Australia for facilitating the donor eye retrieval process. We also thank Dr Andrew Mehnert for his expert advice on image processing.
Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2023/5
Y1 - 2023/5
N2 - The microcirculation plays a key role in delivering oxygen to and removing metabolic wastes from energy-intensive retinal neurons. Microvascular changes are a hallmark feature of diabetic retinopathy (DR), a major cause of irreversible vision loss globally. Early investigators have performed landmark studies characterising the pathologic manifestations of DR. Previous works have collectively informed us of the clinical stages of DR and the retinal manifestations associated with devastating vision loss. Since these reports, major advancements in histologic techniques coupled with three-dimensional image processing has facilitated a deeper understanding of the structural characteristics in the healthy and diseased retinal circulation. Furthermore, breakthroughs in high-resolution retinal imaging have facilitated clinical translation of histologic knowledge to detect and monitor progression of microcirculatory disturbances with greater precision. Isolated perfusion techniques have been applied to human donor eyes to further our understanding of the cytoarchitectural characteristics of the normal human retinal circulation as well as provide novel insights into the pathophysiology of DR. Histology has been used to validate emerging in vivo retinal imaging techniques such as optical coherence tomography angiography. This report provides an overview of our research on the human retinal microcirculation in the context of the current ophthalmic literature. We commence by proposing a standardised histologic lexicon for characterising the human retinal microcirculation and subsequently discuss the pathophysiologic mechanisms underlying key manifestations of DR, with a focus on microaneurysms and retinal ischaemia. The advantages and limitations of current retinal imaging modalities as determined using histologic validation are also presented. We conclude with an overview of the implications of our research and provide a perspective on future directions in DR research.
AB - The microcirculation plays a key role in delivering oxygen to and removing metabolic wastes from energy-intensive retinal neurons. Microvascular changes are a hallmark feature of diabetic retinopathy (DR), a major cause of irreversible vision loss globally. Early investigators have performed landmark studies characterising the pathologic manifestations of DR. Previous works have collectively informed us of the clinical stages of DR and the retinal manifestations associated with devastating vision loss. Since these reports, major advancements in histologic techniques coupled with three-dimensional image processing has facilitated a deeper understanding of the structural characteristics in the healthy and diseased retinal circulation. Furthermore, breakthroughs in high-resolution retinal imaging have facilitated clinical translation of histologic knowledge to detect and monitor progression of microcirculatory disturbances with greater precision. Isolated perfusion techniques have been applied to human donor eyes to further our understanding of the cytoarchitectural characteristics of the normal human retinal circulation as well as provide novel insights into the pathophysiology of DR. Histology has been used to validate emerging in vivo retinal imaging techniques such as optical coherence tomography angiography. This report provides an overview of our research on the human retinal microcirculation in the context of the current ophthalmic literature. We commence by proposing a standardised histologic lexicon for characterising the human retinal microcirculation and subsequently discuss the pathophysiologic mechanisms underlying key manifestations of DR, with a focus on microaneurysms and retinal ischaemia. The advantages and limitations of current retinal imaging modalities as determined using histologic validation are also presented. We conclude with an overview of the implications of our research and provide a perspective on future directions in DR research.
KW - Diabetic retinopathy
KW - Multimodal imaging
KW - Optical coherence tomography angiography
KW - Retinal capillary plexus
KW - Retinal histology
KW - Retinal microcirculation
UR - http://www.scopus.com/inward/record.url?scp=85140957264&partnerID=8YFLogxK
U2 - 10.1016/j.preteyeres.2022.101134
DO - 10.1016/j.preteyeres.2022.101134
M3 - Review article
C2 - 37154065
AN - SCOPUS:85140957264
SN - 1350-9462
VL - 94
JO - Progress in Retinal and Eye Research
JF - Progress in Retinal and Eye Research
M1 - 101134
ER -